Provider Demographics
NPI:1104640861
Name:WALTHER, DEANNE P (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:DEANNE
Middle Name:P
Last Name:WALTHER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SETH DR
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2465
Mailing Address - Country:US
Mailing Address - Phone:609-707-3186
Mailing Address - Fax:
Practice Address - Street 1:10 SETH DR
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2465
Practice Address - Country:US
Practice Address - Phone:609-707-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008762133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty